Gates Open Research最新文献

{"title":"Qualification of a quantitative stability indicating potency assay for mRNA-LNP vaccine candidates.","authors":"Anan Bzami, Marcus Estrada, Tim Schofield, Jessica A White","doi":"10.12688/gatesopenres.16382.1","DOIUrl":"10.12688/gatesopenres.16382.1","url":null,"abstract":"<p><p>Potency assays assess the functional integrity of a target antigen to ensure that the final drug product is consistent between the commercial and clinical trial lots. Existing mRNA-LNP vaccine potency assays require complex quantification methods, such as flow cytometry, which are not widely adaptable to routine use by low- and middle-income country (LMIC) manufacturers or National Regulatory Agency (NRA) laboratories. To address the need for more accessible mRNA-LNP vaccine potency methods, an enzyme-linked immunosorbent assay (ELISA) was developed to quantify the target proteins produced by an mRNA-LNP vaccine after cell transfection. SARS-CoV-2 mRNA-LNP targeting the wild-type (Wuhan) strain was used as a model vaccine for the development and qualification of an ELISA method. The adaptability of the ELISA to other mRNA-LNP vaccines was demonstrated by altering the method used for quantification of a commercial Omicron mRNA-LNP vaccine. Alternative mRNA-LNP potency methods, such as western blotting, fluorescence focus assay (FFA), and direct ELISA were used as analogous methods for comparison. The developed quantitative stability-indicating ELISA is a globally accessible potency method that utilizes existing equipment and knowledge. Testing conducted on wild type SARS CoV-2 and Omicron vaccines demonstrates the adaptability of the method to other mRNA vaccine targets.</p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":"10 ","pages":"26"},"PeriodicalIF":0.0,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing the bacterial surface profiles of menstrual cups and their association with user characteristics and vaginal microbiomes in an adolescent cohort from western Kenya.","authors":"Garazi Zulaika, Rachel Nordgren, Walter Agingu, Adit Chaudhary, Ezekiel Dibondo, Patriciah Wambua, Anna Maria van Eijk, Laura Rusie, Ankur Naqib, Fredrick Otieno, Penelope A Phillips-Howard, Supriya D Mehta","doi":"10.12688/gatesopenres.16380.1","DOIUrl":"10.12688/gatesopenres.16380.1","url":null,"abstract":"<p><strong>Background: </strong>Menstrual cups are increasingly promoted in low-resource settings as long-lasting and cost-effective menstrual hygiene solutions. However, no studies have been done among cup users to characterize the bacterial communities found on cups with long-term use when stored. This study sought to comprehensively characterize the bacterial surface profile of the menstrual cup, identify factors associated with putative pathogens, and quantify the vaginal microbiome as potential source for menstrual cup bacterial communities.</p><p><strong>Methods: </strong>Over 30 months of follow-up, 369 menstrual cup samples were collected from 172 secondary schoolgirls participating in a randomized controlled trial in western Kenya. Samples were obtained from cups brought to school by girls during study visits. Menstrual cup and vaginal microbiomes were assessed using 16S rRNA gene amplicon sequencing. Mixed effects models were applied to identify factors associated with putative pathogens ( <i>Escherichia coli</i>, <i>Staphylococcus aureus</i>, coliform bacteria), and factors associated with vaginal microbiome as potential source environment to bacterial surface profile of the menstrual cup, estimated via fast expectation-maximization for microbial source tracking (FEAST).</p><p><strong>Results: </strong>Menstrual cup bacterial surface profile composition was primarily comprised of soil and water bacteria. However, taxa specific to the vaginal microbiome (e.g., <i>Lactobacillus crispatus</i>, <i>L. iners</i>, and <i>Gardnerella vaginalis</i>) were also recovered from cups. The mean relative abundance (presence) of <i>E. coli</i> and <i>S. aureus</i> was 0.09% (36%) and 0.36% (24%), respectively, with higher relative abundance among participants with HSV-2 or non-optimal vaginal community state type 4. Damaged cups were also associated with higher relative abundance of putative pathogens, while antibiotic use was inversely associated with <i>E. coli.</i> On average, 25.1% of cup microbiota originated from the vagina, with lower contributions among older participants and those with damaged cups. No serious adverse events related to the menstrual cup were observed in the cohort.</p><p><strong>Conclusions: </strong>Interventions focused on improved cleaning and storage tools and methods, and access to clean water and sanitation infrastructure are required to maximize safety of menstrual cup use in low-resource settings.</p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":"10 ","pages":"25"},"PeriodicalIF":0.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13156399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147867869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Child Development and Family Human Capital Investment Decisions in Nigeria: a Study of Selected States in the Six Geo-Political Zones.","authors":"Mohammed Yelwa, Sarah O Anyanwu","doi":"10.12688/gatesopenres.16379.1","DOIUrl":"10.12688/gatesopenres.16379.1","url":null,"abstract":"&lt;p&gt;&lt;p&gt;The study examined child development and family human capital investment decisions in Nigeria. The study focused on household per capita income and family structure using the Nigeria living standard survey for 2018/2019 for the secondary data analysis and a field survey conducted by the researchers in six states in each of the geopolitical zones in Nigeria for the primary data analysis. The study was anchored on household utility maximization theory using the ordinary least squares (OLS) method to analyse the secondary data. Four different results were obtained. First, the result of findings from the OLS estimate revealed that per capita income had no significant impact on Family Human Capital Investment Decisions (FHCID) and male perception of the cost of education had a significant positive impact on FHCID. On the contrary, multi-dimensional poverty index and female perception of the cost of education had an inverse significant impact on FHCID. The second result revealed that average household size, family residence from 1 to 30 minutes proximity to school and 31 minutes and above proximity to school had no significant impact on FHCID. Dependency ratio showed an inverse significant impact on FHCID and family literacy level showed a significant positive impact on FHCID. The third result from the binary logistics regression showed that age, occupation and place of residence of the household head had no significant impact on FHCID. Gender (female-headed household) and education showed an inverse significant impact on FHCID. However, household head years in business or paid employment showed a positive impact on FHCID. The fourth result from the binary logistics regression revealed that marital status had no significant impact on FHCID; family size had a significant negative impact on FHCID; and family structure (type of parents) and number of girl child in the household had a direct impact on FHCID. This study showed complementarities in the home utility function, such that the marginal product of investments rises as family living standards rise. These findings highlight lifetime inequalities and necessitates a special focus on treatments for low-income households. Understanding human capital development and how diverse elements interact is critical to combating poverty and its intergenerational transmission. As a result, this study made several recommendations. First, the importance of persistent action by the government and other donor agencies such as the United Nation Children's Fund (UNICEF) and The World Bank to address the problems of income inequality and pervasive poverty ravaging Nigeria's economy. The study strongly recommends that family, especially parents, maintain justice and fairness within the home, to foster constructive, sympathetic and peaceful home, encouraging most children to exhibit excellent academic performance. Third, government agencies and hospitals, especially in rural areas, intensify family planning and birth","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":"10 ","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13079950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cholera surveillance time series in Africa between 2010 and 2023.","authors":"Qulu Zheng, Rachel DePencier, Maya N Demby, Andrew S Azman, Elizabeth C Lee","doi":"10.12688/gatesopenres.16378.1","DOIUrl":"10.12688/gatesopenres.16378.1","url":null,"abstract":"<p><strong>Background: </strong>Cholera remains a significant public health challenge in Africa, where outbreaks routinely strain public health and healthcare systems. Cholera surveillance time series data could be used to inform the efficient distribution of resources like oral cholera vaccine (OCV) and emergency response personnel, spur research on the impacts of different cholera control activities, and investigate longer-term epidemiologic patterns in cholera dynamics in this region. However, public reporting of cholera surveillance data historically has been sporadic and often limited to outbreak periods, thus limiting the availability of these useful time series datasets. We sought to fill this gap by preparing, cleaning, and processing weekly consecutive time series and outbreak-specific time series from 2010 to 2023 for African countries from heterogeneous data contributed to a global cholera surveillance database.</p><p><strong>Methods: </strong>Cholera incidence data in Africa from 2010 to 2023 on suspected cases, confirmed cases, and deaths were compiled from public and non-public cholera surveillance from multiple sources, including ministries of health, World Health Organization, Médecins Sans Frontières, UNICEF, and other sources. Data were processed by aggregating daily records to weekly levels, averaging duplicate entries, filling gaps and surrounding weeks with zero cases, aligning epidemic weeks, adjusting population data, and removing identifying geographic information to preserve confidentiality as appropriate. Outbreaks were subsequently extracted using a systematic definition and summary statistics were produced by spatial scale and population density. Summary outbreak metrics were compared to previously published cholera outbreak datasets for data validation.</p><p><strong>Conclusions: </strong>The unified surveillance and outbreak datasets provide an extensive compilation of reported cholera activity in Africa from 2010 to 2023, serving as a valuable resource for long-term control planning and early warning systems. Public health researchers can also leverage these datasets to analyze outbreak dynamics, anticipate resource needs, and assess the theoretical impact of control strategies.</p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":"10 ","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13079947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The mini chamber test: a novel bioassay for bioefficacy testing of chlorfenapyr treated nets used in malaria control.","authors":"Amy Lewis, Rowan Jones-Brown, Gemma Harvey, Giorgio Praulins, Emma Reid, Aidi Galus Lugenge, Frank Mechan, Katherine Gleave, Rosemary Susan Lees","doi":"10.12688/gatesopenres.16381.1","DOIUrl":"10.12688/gatesopenres.16381.1","url":null,"abstract":"<p><p>Dual-active-ingredient insecticide-treated nets (Dual-AI ITNs) combining pyrethroids with chlorfenapyr are increasingly being deployed across malaria-endemic areas. Laboratory evaluation of chlorfenapyr ITNs is challenging due to chlorfenapyr's requirement for metabolic activation. Inspired by the tunnel test, the mini chamber test is smaller, has higher throughput, and is animal-free. We optimised the primary parameters using pyrethroid-susceptible and -resistant mosquito strains exposed to new pyrethroid-chlorfenapyr ITNs versus controls. With parameters defined, we used a draft standard operating procedure (SOP) to evaluate the mini chamber against the gold standard tunnel test in a comparator study. The generated data were used to finalise an SOP. The number of mosquitoes per bioassay had no effect on 72 hour mortality on exposure to the pyrethroid-chlorfenapyr net (10, 20, or 30 mosquitoes per mini chamber: 98% vs. 99% vs. 99%, p = 0.46), nor did the chamber orientation (horizontal vs. vertical: 70% vs. 74%, p = 0.35). Mean 72-hour mortality reduced with the length of exposure: 99% with overnight exposure, 74% with 4 hours and 35% with 2 hour exposure. In direct comparisons, the mini chamber gave 95% 72 hour mortality and the tunnel test 70% with overnight exposure. A trend was observed between chemical content (measured by high performance liquid chromatography (HPLC)) and mortality in ITN samples that had been washed 20 times or used in experimental hut trials, compared to unused comparators, when a 6 hour exposure length was used, showing potential for application to durability monitoring. A mini chamber SOP is shared ( https://github.com/i2i-Data-Repository/Mini-Chamber-Test-paper-data-R-code-and-SOP), and further improvements may come from internal and multi-site validation and review of data generated. The method shows promise as an effective bioassay for use where tunnel tests are not available, for measuring the biological activity of chlorfenapyr in ITNs when measuring regeneration times, wash resistance, residual efficacy, and other studies.</p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":"10 ","pages":"14"},"PeriodicalIF":0.0,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Agency in Woman's Economic Empowerment Policy: an Analysis of Three Programs in India.","authors":"Shruti Ambast, Pallavi Khare, Vedavati Patwardhan, Lotus McDougal, Katherine Hay","doi":"10.12688/gatesopenres.16377.1","DOIUrl":"10.12688/gatesopenres.16377.1","url":null,"abstract":"<p><p>The concept of agency has gained prominence in development discourse over the past few decades, reflecting a shift away from top-down approaches and recognition of how individuals and communities shape how and whether programs work. This growing emphasis on agency, and calls for policies and programs that build or expand agency across all major international development funders and implementers, has brought increasing attention to what agency means, how it is shaped, and how to measure it. While research on agency at the intervention level has grown, there has been almost no published analysis of how this growing attention has found home in public policies. In this study, we examine three economic empowerment schemes in India. We adapt an existing framework for empowerment to develop a policy analysis tool and apply it to a textual analysis of the selected schemes. We find several key aspects of agency embedded in the reviewed schemes. All three schemes acknowledge existing gender gaps in access to basic resources and services, and make select resources available and accessible to women (factors which can potentially enhance agency). However, the schemes have less reference to control over resources and the conditions shaping that control. For example, interventions targeting intra-household dynamics and social norms around women's work are generally absent. Likewise, while collective action and connections with other social structures are encouraged in the schemes, contextual and normative factors governing women's ability to act for themselves in such structures are largely unmentioned. The addition of measures targeted at women over time in the schemes suggests growing policy intent around gender equity and agency. Given this intent, we believe this type of policy analysis has promise in suggesting pathways for strengthening agency in the design of individual policies or schemes.</p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":"10 ","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147325673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Practices of African Journals: A Qualitative Analysis from Kenya, Ethiopia, Nigeria, and Mozambique.","authors":"Patrick Amboka, Daniel Krugman, Abel Simiyu, H Kariuki, Benard Ondiek, Nosa Orobaton, Emmy Igonya, Alphonsus Neba, Marta Vicente-Crespo, Julius Kirimi Sindi","doi":"10.12688/gatesopenres.16376.1","DOIUrl":"10.12688/gatesopenres.16376.1","url":null,"abstract":"<p><strong>Introduction: </strong>Information on journal visibility helps researchers decide where to publish. Some quality indicators used are directly associated with the journal's editorial practices. By understanding the barriers, challenges, and opportunities, this study aims to explore existing editorial practices among African journals, explore the underlying factors affecting the editorial practices of African journals, and understand the views and preferences of authors regarding the choice of journals for publication.</p><p><strong>Methodology: </strong>This study triangulated the sources of information and qualitative design data-gathering techniques to allow for nuances and deeper insights into the performance and visibility of African Journals. We conducted In-depth Interviews (IDIs), Key Informant Interviews (KIIs), and Focus Group Discussions (FGDs) in Kenya, Ethiopia, Nigeria and Mozambique. The study population comprised journal editors-in-chief, representatives from African-wide journal databases/indexers, institutional repository representatives, and authors. A purposive sampling technique was used to identify participants. Ethical approval was obtained from the relevant bodies. Qualitative data from the audio-recorded interviews were transcribed using MS Word and exported to NVivo software for analysis.</p><p><strong>Results: </strong>The key structural issues on editorial practices among African journals established by the study included adherence to internationally accepted editorial practices on peer review decision-making and challenges in implementing measures of transparency and rigor. Some of the underlying factors affecting African journal editorial practices that were highlighted included financial constraints, challenges in peer review, challenges in maintaining editorial integrity, and challenges in technological and digital infrastructure. African journals also face challenges of credibility and trustworthiness among authors. Participants outlined how the longstanding neglect of African journals and lack of funding have created cultures of editorial mismanagement, publishing inconsistency, and other logistical issues, all of which contribute to perceptions of African journals as inferior to Northern ones.</p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":"10 ","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146141927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiological Maturity Determination of Wild Banana ( Musa acuminata subsp. malaccensis (Ridl.) N.W.Simmonds) for Seed Conservation.","authors":"Sahromi Sahromi, Aulia Hasan Widjaya, Dian Latifah, Kurniawati Purwaka Putri, Evayusvita Rustam, Muhammad Zanzibar, Yulianti Yulianti, Dwi Murti Puspitaningtyas, Lulut Dwi Sulistyaningsih, Irvan Fadli Wanda, Dewi Ayu Lestari, Lia Hapsari, Enny Sudarmonowati, Apriliana Dyah Prawestri, Fajarudin Ahmad, Witjaksono Witjaksono","doi":"10.12688/gatesopenres.16375.1","DOIUrl":"10.12688/gatesopenres.16375.1","url":null,"abstract":"<p><p>The seed conservation and germination techniques for wild banana seeds are less understood, making this research crucial for developing high-quality seeds that can support sustainable banana breeding efforts. This study examined the reproductive biology and physiological maturity of <i>Musa acuminata</i> subsp. <i>malaccensis</i> to understand seed germination and seedling vigor in order to enhance banana breeding. This research focused on identifying the ideal harvest period to obtain seeds with optimal viability and how ethylene application affects seed quality. Wild banana accessions from the Cibinong Germplasm Collection were used in this study. Ethylene was used to accelerate fruit ripening. Observations were made on the vegetative and generative growth phases and fruit morphology. The physical and physiological qualities of wild banana seeds, M. <i>acuminata</i> subsp. <i>malaccensis</i> can be improved by harvesting between 71-90 days after receptive (DAR). Harvesting during this period increases seed viability and vigor compared to seeds harvested at 50-70 DAR, which showed the highest leachate conductivity value of 968.79 μS g ^-1.</p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":"10 ","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Zero-Dose Childhood Immunization in Conflict-Affected PSNP Districts of Ethiopia: A Comparative Cross-Sectional Study.","authors":"Fisseha Shiferie, Gashaw Andargie Biks, Kidist Negash, Dawit A Tsegaye, Gobena Seboka, Getnet Birhanu, Shibabaw Ewnetie, Tenaye Abate, Uche RalphOpara, Wondwossen A Alemayehu, Joseph Odu, Steven Neri, Frank DelPizzo, Kidist Belete","doi":"10.12688/gatesopenres.16374.1","DOIUrl":"10.12688/gatesopenres.16374.1","url":null,"abstract":"<p><strong>Background: </strong>Childhood immunisation is one of the most cost-effective public health interventions, preventing 4-5 million deaths annually. This study assessed the prevalence and determinants of zero-dose immunisation among children aged 12-35 months in conflict-affected districts implementing Ethiopia's Productive Safety Net Programme (PSNP) to determine whether intervention and comparison areas are comparable before rollout of the enhanced service-integration model.</p><p><strong>Methods: </strong>A comparative cross-sectional survey was conducted among 4,099 mothers and caregivers of children aged 12-35 months in intervention and comparison PSNP districts. Data were collected using a structured questionnaire administered by trained enumerators. Multivariable logistic regression was used to identify factors associated with zero-dose status.</p><p><strong>Results: </strong>Zero-dose prevalence was 30% in intervention districts and 27% in comparison districts, with notable regional disparities: 22.5% in Amhara, 23% in Afar, and 39% in Tigray. Vaccination dropout showed a different pattern, with the highest rate in Afar (57.6%) and the lowest in Tigray (13.6%). DTP3 coverage was lowest in Afar (42.9%) and highest in Amhara (69.4%), while MCV1 coverage was highest in Tigray (83.8%), followed by Amhara (79.6%) and Afar (49.1%). In intervention districts, zero-dose status was significantly associated with region (AOR = 1.5; 95% CI: 1.1-2.2), lack of maternal education (AOR = 1.7; 95% CI: 1.1-2.7), unmarried status (AOR = 1.8; 95% CI: 1.0-3.2), older child age (24-35 months) (AOR = 3.7; 95% CI: 2.6-5.3), and longer distance to health facilities (AOR = 1.4; 95% CI: 1.0-2.2). In comparison districts, region, maternal education, and older child age remained significant predictors.</p><p><strong>Conclusions: </strong>The study highlights persistent inequities in immunisation coverage in conflict-affected settings. It also demonstrates comparability between intervention and comparison PSNP districts in zero-dose prevalence and its determinants. These baseline findings provide a foundation for attributing future post-intervention improvements to enhanced integration of health services within the PSNP framework.</p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":"10 ","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing the use of obstetric care during childbirth in rural Sudan: a qualitative study among healthcare providers.","authors":"Sophie Kellner, Raquel González, Cristina Enguita-Fernàndez","doi":"10.12688/gatesopenres.16373.1","DOIUrl":"10.12688/gatesopenres.16373.1","url":null,"abstract":"<p><strong>Background: </strong>It is estimated that over 287,000 women die annually from childbirth complications, with a substantial proportion living in sub-Saharan Africa. Access to professional obstetric care is crucial for averting these deaths, making it a global health priority. Urgency is heightened by limited literature regarding access to obstetric care, especially in Sudan's rural areas, where maternal mortality peaks. Therefore, the study objective was to identify the perceived barriers and facilitators of accessing obstetric services during childbirth in rural Sudan, specifically in Nuba Mountains, a conflict-ridden isolated region, from the perspective of health experts.</p><p><strong>Methods: </strong>An exploratory qualitative study was conducted from March to May 2023, involving remote in-depth interviews and online questionnaires with 11 health professionals working in maternal and reproductive health in rural Sudan. Thematic analysis was used for the data analysis.</p><p><strong>Results: </strong>Challenges in accessing professional obstetric care in rural Sudan are influenced by sociocultural factors, healthcare perceptions, surrounding individuals, and structural factors. The main barriers identified include social factors such as widespread acceptance of home birth, gender inequality, and family influence; structural barriers like long distances, lack of transport, a deficient referral system, and reliance on untrained healthcare workers; and individual-level factors including low health awareness and limited decision-making autonomy. These barriers are further compounded by political instability, conflict, and displacement in the Nuba Mountains, which severely constrains women's access to obstetric services.</p><p><strong>Conclusion: </strong>While many barriers align with existing literature, unique challenges in Nuba include centralized care, high acceptance of death, lack of a functioning communication network, and an unstable political situation.Barriers preventing women from seeking professional obstetric care during childbirth are complex, with particular challenges in Nuba due to its remoteness and political instability. Future assessments and improvements in care in Sudan should incorporate women's perspectives to ensure a more comprehensive and multidimensional approach.</p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":"9 ","pages":"109"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12708572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145781014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}